title: Impact of rural residence on forgoing healthcare after cancer because of cost.
abstract: BACKGROUND
  Routine follow-up care is recommended to promote the well-being of cancer survivors, but financial difficulties may interfere. Rural-urban disparities in forgoing healthcare due to cost have been observed in the general population; however, it is unknown whether this disparity persists among survivors. The purpose of this study was to examine rural-urban disparities in forgoing healthcare after cancer due to cost.
  
  
  METHODS
  We analyzed data from 7,804 cancer survivors in the 2006 to 2010 National Health Interview Survey. Logistic regression models, adjusting for sociodemographic and clinical characteristics, were used to assess rural-urban disparities in forgoing medical care, prescription medications, and dental care due to cost, stratified by age (younger: 18-64, older: 65+).
  
  
  RESULTS
  Compared with urban survivors, younger rural survivors were more likely to forgo medical care (P < 0.001) and prescription medications (P < 0.001) due to cost; older rural survivors were more likely to forgo medical (P < 0.001) and dental care (P = 0.05). Rural-urban disparities did not persist among younger survivors in adjusted analyses; however, older rural survivors remained more likely to forgo medical [OR = 1.66, 95% confidence interval (CI) = 1.11-2.48] and dental care (OR = 1.54, 95%CI = 1.08-2.20).
  
  
  CONCLUSIONS
  Adjustment for health insurance and other sociodemographic characteristics attenuates rural-urban disparities in forgoing healthcare among younger survivors, but not older survivors. Financial factors relating to healthcare use among rural survivors should be a topic of continued investigation.
  
  
  CONCLUSIONS
  Addressing out-of-pocket costs may be an important step in reducing rural-urban disparities in healthcare, especially for older survivors. It will be important to monitor how healthcare reform efforts impact disparities observed in this vulnerable population.
authors.affiliation: Authors' Affiliations: Social Science and Health Policy, Epidemiology and Prevention, Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, Maryland.
authors.forename: Nynikka R A
authors.initials: NR
authors.lastname: Palmer
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
authors.forename: Lingyi
authors.initials: L
authors.lastname: Lu
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Case
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Weaver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D012424:Rural Population; D017741:Survivors; D016312:Treatment Refusal; D014481:United States; D014505:Urban Population